Boston PainCare
Boston PainCare Center
Yoga Registration Form

Yoga for the Back

Thursday Nights
6:15PM - 7:15 PM

Cost will be $10.00 per session payable by cash or check at the time of the session.

Please register prior to class as space is limited to 15 people. If you have any questions, please call:
781-647-7426 (PAIN)
or email us at: yoga@bostonpaincare.com



Items marked with an asterisk (*) are required.


First Name*
Last Name*
Street Address*
City*
State*
ZIP Code*
Phone - Day*
E-mail
Dates You'd Like to Attend:






Are you a Boston PainCare Center patient?

Yes    No

Name of Your Therapist:

How should we contact you?*

Questions / Comments
   



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